Tyramine is a naturally occurring monoamine compound that is formed from the amino acid tyrosine as foods age, ferment, or spoil. While the body's monoamine oxidase (MAO) enzymes typically break it down without issue, some people lack sufficient MAO or take medications, called monoamine oxidase inhibitors (MAOIs), that block this enzyme. This can lead to a dangerous buildup of tyramine, which triggers the release of norepinephrine, causing a rise in blood pressure, heart rate, and potentially a hypertensive crisis. A low-tyramine diet is crucial for these individuals, as well as for some migraine sufferers who find tyramine to be a trigger.
High-Tyramine Foods to Strictly Avoid
For those on MAOIs, or with a confirmed tyramine sensitivity, avoiding certain foods is critical. The highest concentrations of tyramine are found in products that have been aged, fermented, or cured.
Aged and Fermented Cheeses
Aging increases tyramine content, making these a primary concern:
- Cheddar
- Blue cheese
- Camembert
- Feta
- Gorgonzola
- Muenster
- Swiss
- Provolone
Cured, Smoked, and Processed Meats
Any meat that has been processed or preserved is a high-tyramine source:
- Salami
- Pepperoni
- Dry sausages
- Bacon
- Bologna
- Pickled or smoked fish (like herring or salmon)
- Caviar
- Aged chicken livers
Fermented and Pickled Products
Fermentation is a key process that generates tyramine:
- Sauerkraut
- Kimchi
- Soy sauce and teriyaki sauce
- Miso soup and bean curd
- Fermented tofu and tempeh
Concentrated Yeast Extracts
These products are extremely high in tyramine:
- Marmite
- Vegemite
- Brewer's yeast
Overripe and Select Fruits and Vegetables
While most fresh produce is safe, some exceptions exist:
- Overripe or spoiled fruits and vegetables
- Broad beans (fava beans) and their pods
- Overripe bananas and avocados
Certain Alcoholic Beverages
Tyramine levels can vary widely in alcohol, but some types should be avoided entirely:
- Tap or home-brewed beer
- Red wine
- Sherry
- Liqueurs
Foods with Moderate Tyramine Levels
These foods contain moderate amounts of tyramine and should be consumed in moderation, especially if sensitivity is a concern.
- Certain cheeses: Mozzarella, parmesan, havarti, and brie.
- Chocolate: Contains moderate levels of tyramine.
- Nuts and nut butters: Most varieties contain some tyramine.
- Citrus fruits: Grapefruit, oranges, lemons, and limes.
- Other fruits: Raspberries, grapes, and pineapples.
- Vinegars: Red wine vinegar and apple cider vinegar.
Foods with Low to No Tyramine
For a low-tyramine diet, focusing on fresh, unprocessed foods is key.
- Fresh meat, poultry, and fish: Must be consumed fresh and properly stored.
- Fresh dairy: Milk, cream cheese, ricotta, and cottage cheese.
- Most fruits and vegetables: Fresh or frozen and not overripe.
- Grains: Plain bread, pasta, rice, and cereal.
- Eggs: Freshly cooked eggs are fine.
- Legumes: Most beans, lentils, and peas, except for fava and broad beans.
- Condiments: Ketchup and most standard salad dressings are low in tyramine.
High vs. Low Tyramine Food Comparison
| Food Category | High-Tyramine (Avoid) | Low-Tyramine (Safe) |
|---|---|---|
| Cheeses | Aged cheddar, blue cheese, feta | Cottage cheese, cream cheese, ricotta |
| Meats | Salami, pepperoni, cured sausages | Fresh poultry, pork, and beef |
| Fermented Goods | Sauerkraut, kimchi, miso, soy sauce | Fresh vegetables and fruits |
| Beverages | Red wine, tap beer, home-brewed beer | Bottled beer, gin, rum, vodka, water, coffee |
| Produce | Overripe bananas and avocados, fava beans | Fresh and frozen fruits and vegetables |
Proper Food Handling is Crucial
Tyramine levels increase with time, even in refrigerated foods, which is why leftovers are often a trigger. For those with tyramine sensitivities, it is best to cook and consume food immediately. Any leftovers should be properly stored in the refrigerator or frozen quickly. Avoid eating foods that are past their freshness date or improperly stored, as spoilage can cause a rapid increase in tyramine.
Conclusion: Navigating Your Diet with Knowledge
For most people, tyramine is a non-issue, but for individuals on MAOI medication or those who experience migraines, a low-tyramine diet is a necessary precaution. The key is to avoid aged, fermented, and cured products, prioritizing fresh, unprocessed foods instead. Reading labels and understanding the processes that increase tyramine content is essential for managing your diet safely. If you are taking an MAOI or believe you have a tyramine sensitivity, always consult with a healthcare professional or a registered dietitian before making significant dietary changes. For more information, the Mayo Clinic provides excellent resources on managing diet while taking MAOIs.
